垂体腺瘤经蝶窦显微手术432例

The treatment of 432 patients with pituitary adenomas via transsphenoidal approach

目的研究垂体瘤的临床特征及常规病理和超微结构改变。方法回顾研究４３２例经蝶窦手术治疗垂体肿瘤的临床特点，其中１１９例术中鞍底硬膜活检，光镜检查４２４例，免疫组化检查２９例，电镜检查１０３例，临床结合病理进行分析研究。结果发现鞍区非泌乳素（ＰＲＬ）垂体腺瘤同样可以产生高泌乳素血症；鞍底硬膜有瘤细胞浸及７８例（６５５％）。结论（１）高泌乳素血症并非泌乳素腺瘤所特有，在诊断中应注意鉴别；（２）鞍底硬膜受肿瘤浸及是垂体腺瘤侵袭邻近组织的一个重要标志，与无硬膜浸及者相比，治疗有效率有显著性差异，复发率高，和预后密切相关；（３）根据病情选择合适的疗法，可获得满意效果。

Objective To study some clinical features of 432 cases of pituitary adenomas treated by transsphenoidal microsurgery between July 1982 and October 1996. MethodsZPathological examination, immunohistochemical examination and electronmicroscopic examination were done in 424, 29 and 103 cases respectively.HZResults Hyperprolactinemia was found in many socalled nonfunctioning adenomas besides in prolactinomas. The dura maters were invaded by tumors in 78 cases (the incidence of dural invasion was 655%).HZConclusions Hyperprolactinemia is not peculiar to prolactinomas, and differential diagnosis is necessary when hyperprolactinemia exists. The involvement of the dura mater of sellar floor is an important mark that the adjacent tissues were invaded by pituitary adenomas. The outcome of surgical treatment is significantly different between the patients with dural invasion and without invasion.